Incredible Beauty, Incredible Tragedy: Part 1

By now, a lot of people have probably heard about the devastating floods in the Ladakh area. In fact, you likely know more than I do. We have spent the last 3 days escaping from the area and are just now in Delhi, piecing it all together. One thing I know, though, is how lucky we were to get out, and travel such a long way to safety with few problems. Including the hike, a lot has happened in the last week, both adventurous and tragic. It will probably take a few postings to get it all down.

On August 2nd, four of us left Leh by bus, traveling to Likir to start a 4-day hike in the Sham range. Philip, a young guy from England who work with our team while he is completing an internship with the NGo we were associated with, had done the leg work to arrange the hike. Also joining Doug and I was another Ross, 'American Ross', who had been staying at the same guest house while he volunteered in Leh.

The bus dropped us off in, literally, the middle of no where, around noon. The bus didn't actually go to Likir, so we had to walk from the highway. The area is desert and the altitude as well as the intense Himalayan sunshine made the relatively easy walk that much more difficult. We had a fairly long walk from Likir to Yangthang, where our first homestay was located. The scenery was amazing and the walk was made that much more exciting by a couple of river crossings. The second river crossing involved balancing across a 10-inch log that marked the entrance to the home we were staying in. The 20 foot span over a fairly raging ice cold river required all my concentration, but for the family who lives there, it is their front walkway and even the kids scamper over it without a second thought. Later we were talking to the father and he was telling us how he walks, each day, down the valley to Saspol, a town on the highway, to work in the bank. It is three hours each way. I guess they get used to it early in life, though, as his young son walks two hours each way to school. Tough, and kind, people.

The homes are really interesting. Each one we stayed in had a big kitchen and eating area. Along each wall were many many silver and copper cups and pots. Some of the copper pots and bowls were huge and each obviously served a specific function. These large collections are a sign of wealth for Ladakhi families. There is also a large ornate stove on which the cooking is done. They use wood but also dried dung from yak and cows as fuel. Everywhere you go in Ladakh, you can see dung drying on walls and roofs. Dung from the fields is gathered in the summer and stored.

Following a night in this great guest house we set off for Ulle. Walking was initially a bit stiff, having not really hiked with the pack much for the last couple of years. Ulle is a very small village, only a few houses, higher up the valley and deeper into the mountains. This is a spot I was looking forward to visiting as it is well known for the population of snow leopards that inhabit the area.

The hike up to the village was not as grueling as I was expecting as much of it followed a new jeep path what is being put in. When we arrived in the village, a young guy came out to meet us and inform us that the owners of the home in which Doug and I would be staying was not home. He took us to his home for tea and, during that visit, we got to see his grandfather making curd using traditional methods. This involved pulling back and forth on a length of hide which was wrapped around the stick in the churning bowel. It was really interesting to see traditional ways still being used.

After about an hour rest, the young guy told us the owners of the house had arrived and went with us to show us where to go. I was a bit shocked when we pointed across the massive gorge that splits the village, to a small looking dwelling off in the distance. I was even more taking aback when he indicated the start of the trail, which really was nothing more than loose dirt and rock down the steep side of gorge.

We managed to scramble and stumble down the side until a more distinctive trail appeared. From there, it was down the several hundred feet to the river below, across a rickety bridge, then back up the same several hundred feet to the top of the other side. Of course, when we got there, the owners were no where to be seen and the house was all locked up. We kipped under a tree, in shade and discomfort, for a couple of hours until we decided to bail and try the guesthouse that the other two were staying at which, fortunately, was on the same side of gorge as we were now on. A half an hour march and some negotiating with the kids who lived in the house and were the only ones around and we had a place to stay. This was convenient as we were now all staying in the same place and we had arranged for a local guide to meet us there the next morning to go searching for snow leopards....

Bits and pieces

This is the view that I see each morning from the balcony of the Phanday Guest House. Lama Konchok Phanday, the owner of the guest house is a well-known buddhist monk in Leh. He became a monk at the age of eleven, against his family's wishes because he wanted to improve his reincarnation prospects. An interesting man who laughs all the time. The view is looking out across the Indus valley to the Hemis National Park and Stok Kangri, the largest of the Himalayas in this area.

Four of us have booked a 5 day trek to the Sham area. Here is another pic I nicked from the net. The Sham trek is considered an easy trek; many of the treks here involve going over passes of more than 5000m but not this one. Even though this is a short trek, it will be one of the great hikes of my life. I have been looking forward to treking since I got here. There are hundreds of miles of treks in the Ladakh area but the director of the Snow Leopard Conservatory picks Sham as his favourite. We will be doing it as a home-stay trek, staying in Ladakh homes. That should add an interesting dimension. We will stay in one village for two days because the local information is that this is a great place to see snow leopards. Fingers crossed, but I think we will be extremely lucky if that happens. We should, however, see yak and ibex.

Opening the unit

Here is another picture, stolen from the net, to give a better impression of Leh (this one is Shanti Stupa, the spot we walk up to in the morning for exercise). Downloading pictures from my camera has proven to be impossible, given the sketchy internet access and high probability of getting a bunch of viruses on my memory cards.

The project that the team was working on, opening the paediatric unit for disabled children at Sonam Norboo Memorial Hospital, has come the end with the grand ribbon cutting ceremony. The Minister of Health for Jammu Kashmir, as well as the Minister of Tourism were in attendance, as well as a great number of armed soldiers, given that this is Kasmir. The actual ceremony was pretty quick; unveil the plaque, have a look around, then a quick press conference. Still, the Minister did take a few minutes to thank the Canadian Team for their efforts.

The unit looks pretty great, compared to how it looked when we arrived. It is cleaned up, tidied, and painted. Quite a few kids have been through the unit already and many return for ongoing therapy with Dolma, Norboo, and Tsewang, now that the rest of the team has left. Other than Doug and I, the remaining team members flew out yesterday. Doug and I will continue to work this week, to complete the seating systems we were working on with the folks from REWA. The seats are looking awesome, if I do say so my self. Earlier this week, we had a cobbler sew up shoulder straps and on Friday, we will finish putting the whole thing together.

After that, it is off for some adventure, which I will report on later.....

Ross

Back to Leh

[pictures to follow, when there is decent internet]

During the time that we were in Kargil, things were developing at the Sonam Norboo Memorial Hospital paediatric rehab unit. Radio announcements had gone out, informing parents in Leh and the surrounding villages that there was a team from Canada at the hospital for the month of July. Some of the changes we had suggested before leaving for Kargil had been put in place, others were still waiting to be done.

Over the next few days, there was a trickle of kids into the unit. One of the children I saw had been followed by the team in previous years. She was now living at a boarding school just south of Leh. I was tasked with making a soft hand splint as she is hemiplegic so requires support to keep one of her hands open. It was a good exercise in designing and fabricating aids from available resources. I found some felt material in the market but this proved to be not stiff enough. I was able to scrounge up a piece of neoprene that did the trick but it would be better if we were able to make the splints from locally available materials, like soft leather, in the future.

Since things have been a little slow at the hospital, Doug, Maureen and I spent some time at REWA Society. REWA is an organization started by a German couple and now run by local Ladakhis. Their goal is to provide physical and occupational therapy services to children in and around Leh. They bring volunteer therapists from Europe for several months at a time, year round. They have set up a pretty well stocked rehab centre and also do trekking outreaches to remote villages. At the time we went, they had several physios on staff but no OT.

One of the tasks REWA required was fabrication of two seating systems for children with Cerebral Palsy. Maureen is an expert in seating and positioning, so she was able to lead us through assessing and measuring the children. We then drew up plans for the seats, hopefully improving on the style they currently use by making ours adjustable for growth. This coming week, I’ll need to find someone who can fabricate metal brackets and will work with the carpenter to actually build the seats. After that, I’ll be with Maureen again to cut and fit the foam that will give the seat the required fit and postural control. That should be a good learning experience.

Armin, one of the physios at REWA, also told us that a kid he has been working with needed some changes to her home environment. Sonam is a 16 year old girl with spina bifida, paralyzed from the waist down. She is a real bright spark, very personable and who loves school. The family bathroom at home is outside, down a very narrow alley at the side of the house. To use the bathroom, her mother has to carry her down this narrow gap. I seriously couldn’t walk down the alley without having to turn sideways so I have to idea how her mother was able to negotiate this path with Sonam on her back. After a look around, we suggested constructing a new, wheelchair accessible bathroom space in the front of the house. With the family, we decided on a spot next a small shed. Next week, we should begin construction. This should be another great learning experience as we will build a wall for the bathroom and roof using traditional Ladakhi materials and construction techniques, plus a few OT suggestions to make it accessible and practical.

I’ve also been able to get more familiar with Leh. It is a difficult town to get around as much of it is made up of a maze of narrow, walled pathways. I feel like I can get from one spot to another without too much difficulty, though it is not easy to know if you are ever going the most direct route from Point A to Point B. The market area is pretty interesting. Lot’s of small shops selling everything to the tourists. My favourite part are the old ladies who sell produce off the side walk along one of the stretches. Their fare changes as new local crops become available. Yesterday, I picked up some carrots and kohlrabi, to try and bump up the intake of veggies. I think it cost about $1.50 for a bag full.

I’ve also managed to get out to see a few of the other attractions. Shanti Stupa is a giant Buddhist monument, built by a Japanese group in the 1980’s. It makes for a good morning trek before breakfast and gives amazing views of the town and Indus Valley. Last weekend, we also toured the Leh Palace. It is in a bit of disrepair right now, but at one time was the tallest building in the world. It is in the process of being restored by a volunteer group. Above the palace is a monastery so we also made the trek up there.

Clinics in Sankoo and Panakar

Our first outreach was held at the hospital in Sankoo. Sankoo is about 20 000 people, but it really is a village as there is little infrastructure; just a single street with small open front stores and lots of fields, mostly barley. It is pretty easy to see the gender divisions; men run the businesses, which appear to mean a lot of sitting around, and women work in the fields and carry heavy loads of barley and hay in baskets on their backs.

The Sankoo Hospital, out of which our outreach was based, is fairly new. Dr. Khan had done a good job of getting the word out and organizing rides so many people from remoter areas could get their children to the clinic. Our outreaches were intended for disabled children but attracted a whole variety of ages and health concerns. Our team was divided into three areas. Kids would first be seen by developmental paediatrician Carey Matsuba and would then be sent to our special educator or the occupational/physical therapy team, or both, depending on their needs.

The role of the occupational therapy team was to assess any difficulties that someone might be having performing any range of daily activities. Occupational Therapy is concerned with improving a person’s participation in their daily activities. Since the person may be having difficulty because of physical, cognitive, or mental health reasons, occupational therapy looks at all of those possibilities. We saw lots of kids with cerebral palsy or other developmental concerns and so, interviewing the parents, worked with them to show them how to do stretches in order to prevent contractures or how to position to help with feeding.

A good example of the OT process in action was the young guy and his aunt who cared for him, who came in with the specific goal of improving his ability to use the toilet. It was helpful that they had that clear goal because it made it easy to work with them to figure out ways we could help. He was around twenty, with CP but could walk. He just couldn’t use the toilet. Toilets in India are the type you squat over, which is difficult or impossible to use if you have mobility issues. We were able to do a quick assessment of his physical capabilities, trial a couple of ideas, and sketch out an idea for a bench and handle to go over the pit toilet so he would be able to sit instead of squat. He and his aunt took the sketch off with them to find a carpenter to fabricate it. They were pretty pleased, as were we to have been able to help. However, it did illuminate one of the weaknesses of running a clinic in a hospital. The clinics were designed as a needs assessment, to determine the extent of need for services in the area. That aspect is important but as OTs, we would have been able to offer more if we had been working in his community and actually been able to look at his home environment. Hopefully, that is something that will be able to develop in the future for Kargil.

After that successful clinic, we moved up the valley to the village of Panakar. We had another, one-day clinic scheduled in this remote mountain village. This could be the most beautiful place I have been. The drive follows a rough road from Sankoo into the higher alpine, winding its way along a raging river. The size of everything here is on a huge scale. The volume and speed of the river is intimidating. The smaller mountains that rise up from the river are large by British Columbia standards. Panakar is near the end of this great valley. Just above the town, behind a ridge, sit Nun and Kun, twin summits, which at over 22 000 feet, are the highest summits in the area. When we were flying in from Delhi to Leh, we could only see two peaks jutting above the clouds, which we have since identified as Nun and Kun. They are really beautiful mountains, though it wasn’t until we were heading back to Kargil that we were lucky enough to get a cloudless view of them.

Panakar is also heavily reliant on agriculture, mostly grains and hearty vegetables that can ripen in the short growing season. One of the most interesting aspects of the village is the irrigation system. Channels are built higher up in the mountain streams to divert water. Most of the channels are trenched into the top of dykes and run at a constant grade across and down the hills and through out the town to irrigate all of the fields. There are miles and miles of channels and intricate systems of dams to divert the water from one field to another. When we arrived in the village, the crew of doctors and medical staff who are stationed there took us for a long walk around the village and the fields. It was great to be able to see so much of the area during such a short stay.

In the morning, I was able to scramble up a small hill and get some pictures of the town. It was really beautiful in the morning light. There is not much in the way of modern amenities, other than the cars and satellite dishes. Electricity is only available for a couple of hours in the evening. Things are changing though. Illustrating the convergence of old ways and new technology in this region, on the way up the valley we saw big crews of labourers using hoes and shovels to dig miles of trench by hand. I thought it might be another irrigation system but it turns out the trench is for fiber-optic cable which will eventually bring broadband right up the valley to Panakar.

During the drive back to Kargil, Dr. Khan took us on a bit of a detour to another very small village on the other side of the valley. One of the advantages of travelling with a person who knows the area so intimately is that you get to participate in random, off the beaten path, experiences. While building his home, one of the villagers had unearthed some ancient Buddhist or pre-Buddhist artifacts. We were able to visit these priceless stone carvings, which are propped up in his living room. Dr. Khan, whose father was a historian who wrote several books about the area, is concerned about what will become of these relics and is working to protect them.

By the time we arrived back in Kargil, things had changed. We first noticed something was different when we encountered a grid-locked traffic jam. Turns out the otherwise peaceful Islamic town had changed temporarily into something of a hot-bed of Islamic Fundamentalism. Many people had travelled to Kargil to hear a reputedly controversial Iranian cleric speak. Apparently, this cleric lives in one of the big cities in India and travels around now to deliver speeches and stir people up.

We managed to drive through the heavy traffic until we were blocked by a fist-raising, flag-waving throng. The rally was being held right on the streets in the middle of town so there was no moving further by car. Sitting in the car, you get a trapped feeling, and so we thought it would be better to keep moving away from the crowd. We asked Dr. Neufeld, who was with Doug, Carey, and I in one jeep, if there it was possible to walk from there to the guest house, via a different route. He said there was so we loaded up our own packs and the packs of the other team members and started off on foot. Loaded down with packs, instead of leading us away from the demonstration, Dr. Neufeld led us straight into the packed crowd. With the speakers revving up the crowd over the megaphone and hundreds of fists going up in the air in unison with hundreds of shouts, I was thinking, ‘This is not a good idea’. The whole atmosphere was electric, and I was hoping I didn’t accidentally step on any toes, literally, as we pushed through the crowd. As it was, under the weight of the big packs, we had to bump and squeeze to create a path to get through. Fortunately, we only had to dodge around the outside of the crowd and, as soon as we popped out the other side, we found ourselves in the same bustling, peaceful market area that we had driven through a few days before. Like most other places, the majority of Kargil residents are content to go about their lives peacefully and a minority of residents wants to create change by imposing on others their beliefs. This seems to be what the rally was all about; it seemed large and intimidating when we were stuck in the middle, but was only a small event in the larger scheme of the town.

After a restful night in a comfortable guest house, we spent the morning touring a special education classroom run by the Indian army. With its proximity to, especially Pakistan but also China, there is a great military presence through out the Kashmir-Ladakh region. To help keep the peace, there are several public relations-type initiatives managed by the army. Most kids are driven to school by the army, in buses and even in the backs of military transport trucks. The army also operates classes for special-needs kids on the bases in Kargil and Leh. The class was well equipped and even had a physical therapy space, though the physical therapist who was posted there now worked for the Kargil hospital.

After leaving the army base, we headed north out of Kargil along a road which Dr. Khan described as better than the route we had used to get there a few days before. He was correct. This route is primarily a military road (apparently, you need a pass to travel on it), which travels along the line of control with Pakistan, following mostly the Indus river. It is definitely one of the most spectacular drives you could ever take. Shortly after leaving Kargil, the road climbs up to a high pass at around 14 000 feet in a sea of rock and scree. It then drops down into an impossibly steep, narrow gully that makes its way down the side of a mountain, eventually arriving at the side of the milky Indus river.

The Indus is an interesting river, politically. Its head waters arise in China, it flows through India (and gives the country its name), then into Pakistan, where it is the primary source of water. As it flows along the route we drove, it cuts its way through a steep, high, and narrow gorge. It is an impossible place for a road and yet there is one there. In many sections, the rock is so steep that a road could not be graded so it is cut directly into the rock, creating sort of a three-sided tunnel, with millions of tons of mountain just a few feet above the roof of the car. Along the way, we passed several small villages on both sides of the river. Those on the opposite bank were accessed using rickety bridges or tiny cable-drawn baskets strung above the boiling river.

One of the difficulties with traveling a road intended for military use is the many military check points. Even though it would be impossible to enter or exit the gorge at any point between start and finish, we were required to stop at each one and have our papers and passports checked. At the first, I was singled out by the soldier, which was a bit scary. He wanted to know which one of us was ‘Ross Taylor’. I did a quick panicked scan of my brain, trying to recall if I had any outstanding warrant or the like. As it turns out, I share the same name with a famous cricket player and cricket was the single interest of the soldier (we asked about the World Cup but he didn’t know). At a further check point, we pulled out a camera to show pictures of us with the base commander and that seemed to be a bit of a hit also.

Overall, it was a great trip to Kargil (other than the illness), and after several more hours of driving, we arrived back in Leh, ready to begin clinics here.

Ups and Downs in Kargil

Last Thursday, six of us left Leh to make the 275km, 9-hour journey to Kargil. The journey takes a long time because the road, National Highway 1D, isn’t the freeway that the name suggests. It varies in quality, from a short section of two lane hard-top to dirt track. Mostly it is dirt track making for a bumpy and dusty ride, which you share with an endless stream of trucks, buses, cars, and motorcycles. The entire trip is a continuous series of near head-on collisions on the single lane track. To allow the large cargo and army trucks to pass, I thought we would pull over into the slightly wider areas at the edge of the road. Actually, we just went head-on, pulling slightly to the left at the last second, as the on-coming truck did the same, providing just enough room to squeeze by, even on the side of a gorge.

The mountains that the road is carved through are older, looser rock and the road has been dug through massive scree slopes that rise at an impossible angle, to unbelievable heights. On the far side, I could see sections where the loose slopes had slid like avalanches in the past, covering all the tracks in its path. This could be why the road is continually under repair and does not add to one’s peace of mind. All along the way, we came upon crews of road builders, fixing and building the road and supporting walls by hand, breaking rocks with hammers and chisels. Many of the road builders have children who spend their time at the job site and we even saw the odd baby lying at the side of the highway having a nap.

The entire trip was incredibly scenic. The highlight for me was the climb above the monastery of Lamayuru. A new section of the highway was closed for repair so we were routed up the old road; a steep section of 23 or so switchbacks that climbs from river-level, up the steep side of a mountain until it reaches the top, just a little higher than 14 000 feet. The drive up was made all the more death-defying by the trucks we had to pass on the narrow road. At some points, when the jeep edged past a truck, I could peer straight down to the river below, probably a drop of two or three thousand feet. When we stopped at the top, my face and hands were tingling again from the effects of the altitude. The views across the high plateau and mountain ranges were unbelievable.

Later, we stopped in a tiny town, at the only restaurant, for a rest and tea before continuing on to Kargil. Across the street, we noticed a Buddhist shrine. It was the site of a massive sculpture, carved into the side of a huge boulder. Just a random find that brings home how much there is to discover in this part of the world.

While the region we are working in is predominantly Buddhist, by the time you get to Kargil, you have moved into the Muslim areas of Northern India. Kargil is a small town sitting on the line of control between India and Pakistan, not the type of place where you will find lots of tourists. Sitting on the deck of our guest house we could look at the peak which formerly marked the border. In 1999, Kargil found itself at the centre of the ongoing disputes between India and Pakistan concerning Kasmir in what is known as the Kargil War. Parts of the town, including the hospital, which is just a stone's throw from our guest house, were shelled during the conflict and there were many civilain and military casualties.

When we arrived in Kargil, we met up with Dr. Akbar Khan, the E.N.T. surgeon who had arranged our visit and organized the village outreaches which we would begin the next day. Dr. Khan is a very interesting guy, who was always willing to talk to us about health care, politics, and culture. He described how, when growing up in a nearby village, the family had only one pair of pants between five people. They would have to hang them on the door in the winter so if someone needed to go out, the pants would be available. And, they were the rich family in the village. He wasn’t joking. He used to play in the snow for hours in the winter, without shoes on. Tough people. This is one of the coldest inhabited places on earth, with the temperature reaching -40C in the winter.

Dr. Khan organized a welcome meeting and dinner for us. He invited most of the local doctors and we had some interesting talks about Canada and India. We had an interesting conversation about how much this area has changed as a result of global warming. Over the past 20 years, the glaciers have receded significantly, which is concerning as this is the source of all the drinking water for this arid region. One doctor thought that there would not be people living in the area in another 20 years due to the lack of available water. They have also begun to see cases of malaria in the area, something which was previously unknown.

Shortly after this interesting meeting, I hit the ‘downs’ part of the ‘Ups and Downs of Kargil’. Some poor roadside decision caught up to me and I got as sick as I have ever been. Two solid days of hell, the first of which was spent up all night in the crappiest bathroom in the most dismal room in the guest house. The next morning, I was able to make the trip to the first village, Sankoo, hopped up on a cocktail of Gravol, Immodium, and Cipro. Still, the worst part wasn't so much the puking, it was having to eat, day after day, the same rice and dal that I had been throwing up.

But, after a day of recovery, I was ready to join the rest of the team at the outreach for disabled children.